淋巴-血管侵犯（LVI）在肾细胞癌（RCC）患者中被认为是一种不良的病理特征。然而，它对总生存率（OS）的影响尚不清楚，并且在文献中鲜有讨论。我们旨在利用一个庞大的北美队列评估LVI作为RCC患者OS预测因子的预后能力。我们纳入了95,783例2010年至2015年间诊断的cM0 RCC患者，所有患者在国家癌症数据库中接受了部分或全肾切除术。采用Kaplan-Meier曲线和log-rank检验来描述和比较生存曲线。Cox回归分析调整了所有可用混杂因素，检验了LVI对OS的影响。平均年龄（标准差）为59（12），大多数患者为pT1期（72.2%）。有14.5%的淋巴结状态为pN0，2.3%为pN1，83.3%为pNx。总体而言，9.0%的患者存在LVI。队列的平均（标准差）随访时间为39个月（24）。在5年时，LVI患者的OS为65%，无LVI患者为86%（p<.0001）。当根据淋巴结疾病阶段对患者进行分层时，这些比率分别为pN0患者的64% vs 78%，pN1患者的31% vs 41%，pNx患者的69% vs 87%（所有P < 0.001）。多变量分析显示，在与无LVI患者相比，LVI患者在同时患有pN0、pN1和pNx疾病时具有1.37倍（P < 0.001）、1.18倍（P = 0.068）和1.53倍（P < 0.001）的死亡风险。据我们所知，这是首次清楚地证明了手术治疗的RCC患者中LVI对OS的不利影响。这些发现可能对术后患者咨询有用，并在设计未来的临床试验时需要加以考虑。版权所有© 2023 Elsevier Inc.。保留所有权利。

Lymph-vascular invasion (LVI) is recognized as an adverse pathological feature in patients with renal cell carcinoma (RCC). However, its impact on overall survival (OS) is not clear and scarcely addressed in the literature. We aimed to assess the prognostic ability of LVI as a predictor of OS in RCC patients using a large, North American cohort.We included 95,783 cM0 RCC patients, diagnosed between 2010 and 2015, who underwent partial or radical nephrectomy within the National Cancer Database. Kaplan-Meier curves and log-rank tests were used to depict and compare survival curves. Cox regression analysis tested the impact of LVI on OS, after adjusting for all available confounders.Mean age (SD) was 59 (12), and most patients had pT1 stage (72.2%). Nodal status was pN0, pN1, and pNx, in 14.5%, 2.3%, and 83.3%, respectively. Overall, 9.0% of patients had LVI. The mean (SD) follow-up of the cohort was 39 months (24). At 5 years, OS was 65% in patients with LVI vs. 86% in patients without LVI (p<.0001). When patients were stratified based on nodal stage, these rates were 64% vs. 78% in pN0 patients, 31% vs. 41% in pN1 patients, and 69% vs. 87% in pNx patients (all P < 0.001). On multivariable analysis, and in comparison to patients without LVI, those with LVI had 1.37- (P < 0.001), 1.18- (P = 0.068), and 1.53-fold (P < 0.001) greater risk of death, when also harboring pN0, pN1, and pNx disease, respectively.Our findings are the first, to our best knowledge, to illustrate the clear detrimental impact of LVI on OS in surgically treated RCC patients. These findings might be useful in postoperative patient counseling and need to be accounted for when designing future clinical trials.Copyright © 2023 Elsevier Inc. All rights reserved.